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[Article of Interest] High Deprivation, Population Density And Inequality Found To Increase Rates Of SchizophreniaArticle adapted by Medical News TodayHigher rates of schizophrenia in urban areas can be attributed to increased deprivation, increased population density and an increase in inequality within a neighbourhood, new research reveals. The research, led by the University of Cambridge in collaboration with Queen Mary University of London, was published in the journal Schizophrenia Bulletin.Dr James Kirkbride, lead author of the study from the University of Cambridge, said: “Although we already know that schizophrenia tends to be elevated in more urban communities, it was unclear why. Our research suggests that more densely populated, more deprived and less equal communities experience higher rates of schizophrenia and other similar disorders. This is important because other research has shown that many health and social outcomes also tend to be optimal when societies are more equal.”The scientists used data from a large population-based incidence study (the East London first-episode psychosis study directed by Professor Jeremy Coid at the East London NHS Foundation Trust and Queen Mary, University of London) conducted in three neighbouring inner city, ethnically diverse boroughs in East London: City & Hackney, Newham, and Tower Hamlets.427 people aged 18-64 years old were included in the study, all of whom experienced a first episode of psychotic disorder in East London between 1996 and 2000. The researchers assessed their social environment through measures of the neighbourhood in which they lived at the time they first presented to mental health services because of a psychotic disorder. Using the 2001 census, they estimated the population aged 18-64 years old in each neighbourhood, and then compared the incidence rate between neighbourhoods.The incidence of schizophrenia (and other similar disorders where hallucinations and delusions are the dominant feature) still showed variation between neighbourhoods after taking into account age, sex, ethnicity and social class. Three environmental factors predicted risk of schizophrenia - increased deprivation (which includes employment, income, education and crime) increased population density, and an increase in inequality (the gap between the rich and poor).Results from the study suggested that a percentage point increase in either neighbourhood inequality or deprivation was associated with an increase in the incidence of schizophrenia and other similar disorders of around 4%.Dr Kirkbride added: “Our research adds to a wider and growing body of evidence that inequality seems to be important in affecting many health outcomes, now possibly including serious mental illness. Our data seems to suggest that both absolute and relative levels of deprivation predict the incidence of schizophrenia."East London has changed substantially over recent years, not least because of the Olympic regeneration. It would be interesting to repeat this work in the region to see if the same patterns were found."The study also found that risk of schizophrenia in some migrant groups might depend on the ethnic composition of their neighbourhood. For black African people, the study found that rates tended to be lower in neighbourhoods where there were a greater proportion of other people of the same background. By contrast, rates of schizophrenia were lower for the black Caribbean group when they lived in more ethnically-integrated neighbourhoods. These findings support the possibility that the socio-cultural composition of our environment could positively or negatively influence risk of schizophrenia and other similar disorders.Dr John Williams, Head of Neuroscience and Mental Health at the Wellcome Trust said: “This research reminds us that we must understand the complex societal factors as well as the neural mechanisms that underpin the onset of mental illness, if we are to develop appropriate interventions.”

[Article of Interest] High Deprivation, Population Density And Inequality Found To Increase Rates Of Schizophrenia
Article adapted by Medical News Today

Higher rates of schizophrenia in urban areas can be attributed to increased deprivation, increased population density and an increase in inequality within a neighbourhood, new research reveals. The research, led by the University of Cambridge in collaboration with Queen Mary University of London, was published in the journal Schizophrenia Bulletin.
Dr James Kirkbride, lead author of the study from the University of Cambridge, said: “Although we already know that schizophrenia tends to be elevated in more urban communities, it was unclear why. Our research suggests that more densely populated, more deprived and less equal communities experience higher rates of schizophrenia and other similar disorders. This is important because other research has shown that many health and social outcomes also tend to be optimal when societies are more equal.”
The scientists used data from a large population-based incidence study (the East London first-episode psychosis study directed by Professor Jeremy Coid at the East London NHS Foundation Trust and Queen Mary, University of London) conducted in three neighbouring inner city, ethnically diverse boroughs in East London: City & Hackney, Newham, and Tower Hamlets.
427 people aged 18-64 years old were included in the study, all of whom experienced a first episode of psychotic disorder in East London between 1996 and 2000. The researchers assessed their social environment through measures of the neighbourhood in which they lived at the time they first presented to mental health services because of a psychotic disorder. Using the 2001 census, they estimated the population aged 18-64 years old in each neighbourhood, and then compared the incidence rate between neighbourhoods.
The incidence of schizophrenia (and other similar disorders where hallucinations and delusions are the dominant feature) still showed variation between neighbourhoods after taking into account age, sex, ethnicity and social class. Three environmental factors predicted risk of schizophrenia - increased deprivation (which includes employment, income, education and crime) increased population density, and an increase in inequality (the gap between the rich and poor).
Results from the study suggested that a percentage point increase in either neighbourhood inequality or deprivation was associated with an increase in the incidence of schizophrenia and other similar disorders of around 4%.
Dr Kirkbride added: “Our research adds to a wider and growing body of evidence that inequality seems to be important in affecting many health outcomes, now possibly including serious mental illness. Our data seems to suggest that both absolute and relative levels of deprivation predict the incidence of schizophrenia.
"East London has changed substantially over recent years, not least because of the Olympic regeneration. It would be interesting to repeat this work in the region to see if the same patterns were found."
The study also found that risk of schizophrenia in some migrant groups might depend on the ethnic composition of their neighbourhood. For black African people, the study found that rates tended to be lower in neighbourhoods where there were a greater proportion of other people of the same background. By contrast, rates of schizophrenia were lower for the black Caribbean group when they lived in more ethnically-integrated neighbourhoods. These findings support the possibility that the socio-cultural composition of our environment could positively or negatively influence risk of schizophrenia and other similar disorders.
Dr John Williams, Head of Neuroscience and Mental Health at the Wellcome Trust said: “This research reminds us that we must understand the complex societal factors as well as the neural mechanisms that underpin the onset of mental illness, if we are to develop appropriate interventions.”

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artfromtheedge:

The creators of the Serious Mental Illness blog invite you to submit your visual art, photography, video work, music, poetry, collage, or short fiction to Art from the Edge. 
Art from the Edge, a virtual gallery and resource center, is dedicated to art created in and about extreme mental states. It is an open and public world wide forum for artists to share their visual and written works and their personal stories with all those interested in the connection between creativity and “edge” states.
Much like art, which exists in a multitude of mediums and forms of expression, there are a plurality of “edge” states that inspire the artists who harbor them. For this reason, we leave the term completely open to our community’s interpretation, knowing from research and experience that this state could be driven by psychosis or trauma, or an altered state induced by drugs. It could be the offshoot of extreme depression or grief, or the aftermath of a spiritual or mystical state of consciousness.
Ultimately, we are interested in the artist’s individual experience and in his or her sense of what it is that drove the creative act. 
submissions@artfromtheedge.net
artfromtheedge.net

artfromtheedge:

The creators of the Serious Mental Illness blog invite you to submit your visual art, photography, video work, music, poetry, collage, or short fiction to Art from the Edge. 

Art from the Edge, a virtual gallery and resource center, is dedicated to art created in and about extreme mental states. It is an open and public world wide forum for artists to share their visual and written works and their personal stories with all those interested in the connection between creativity and “edge” states.

Much like art, which exists in a multitude of mediums and forms of expression, there are a plurality of “edge” states that inspire the artists who harbor them. For this reason, we leave the term completely open to our community’s interpretation, knowing from research and experience that this state could be driven by psychosis or trauma, or an altered state induced by drugs. It could be the offshoot of extreme depression or grief, or the aftermath of a spiritual or mystical state of consciousness.

Ultimately, we are interested in the artist’s individual experience and in his or her sense of what it is that drove the creative act. 

submissions@artfromtheedge.net

artfromtheedge.net

(Source: )

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[Article of Interest] Adolescent Stress Linked to Severe Adult Mental Illness
ScienceDaily.com
Working with mice, Johns Hopkins researchers have established a link between elevated levels of a stress hormone in adolescence — a critical time for brain development — and genetic changes that, in young adulthood, cause severe mental illness in those predisposed to it.
The findings, reported in the journal Science, could have wide-reaching implications in both the prevention and treatment of schizophrenia, severe depression and other mental illnesses.
“We have discovered a mechanism for how environmental factors, such as stress hormones, can affect the brain’s physiology and bring about mental illness,” says study leader Akira Sawa, M.D., Ph.D., a professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine. “We’ve shown in mice that stress in adolescence can affect the expression of a gene that codes for a key neurotransmitter related to mental function and psychiatric illness. While many genes are believed to be involved in the development of mental illness, my gut feeling is environmental factors are critically important to the process.”
Sawa, director of the Johns Hopkins Schizophrenia Center, and his team set out to simulate social isolation associated with the difficult years of adolescents in human teens. They found that isolating healthy mice from other mice for three weeks during the equivalent of rodent adolescence had no effect on their behavior. But, when mice known to have a genetic predisposition to characteristics of mental illness were similarly isolated, they exhibited behaviors associated with mental illness, such as hyperactivity. They also failed to swim when put in a pool, an indirect correlate of human depression. When the isolated mice with genetic risk factors for mental illness were returned to group housing with other mice, they continued to exhibit these abnormal behaviors, a finding that suggests the effects of isolation lasted into the equivalent of adulthood.
“Genetic risk factors in these experiments were necessary, but not sufficient, to cause behaviors associated with mental illness in mice,” Sawa says. “Only the addition of the external stressor — in this case, excess cortisol related to social isolation — was enough to bring about dramatic behavior changes.”
The investigators not only found that the “mentally ill” mice had elevated levels of cortisol, known as the stress hormone because it’s secreted in higher levels during the body’s fight-or-flight response. They also found that these mice had significantly lower levels of the neurotransmitter dopamine in a specific region of the brain involved in higher brain function, such as emotional control and cognition. Changes in dopamine in the brains of patients with schizophrenia, depression and mood disorders have been suggested in clinical studies, but the mechanism for the clinical impact remains elusive.
To determine whether cortisol levels were influencing dopamine levels in the brain and adult behavioral patterns in the abnormal mice, the investigators gave them a compound called RU486, known to block cells from receiving cortisol. (The drug is commonly known as the “abortion pill.”) All symptoms subsided. RU486 has also been studied in a clinical trial of people with difficult-to-treat psychotic depression, showing some benefits. “The mice swam longer, they were less hyper and their dopamine levels normalized,” Sawa says.
To shed light on how and why the mice got better, Sawa and his team studied the gene tyrosine hydroxylase (Th) and found an epigenetic change, essentially the addition of a methyl group to one of the gene’s DNA letters, limiting the gene’s ability to do its job, which is to create an enzyme that regulates dopamine levels. Without a fully functioning Th, dopamine levels are abnormally low.
Scientists have long studied gene mutations, permanent DNA changes that can tweak the normal function of a particular gene. But epigenetic alterations do not change the actual letters of the DNA sequence. Instead, they add a chemical group like methyl that can affect the function of the DNA. These changes can be transient, whereas genetic mutations are permanent.
Sawa says the new study points to the need to think about better preventive care in teenagers who have mental illness in their families, including efforts to protect them from social stressors, such as neglect. Meanwhile, by understanding the cascade of events that occurs when cortisol levels are elevated, researchers may be able to develop new compounds to target tough-to-treat psychiatric disorders with fewer side effects than RU486 has.

[Article of Interest] Adolescent Stress Linked to Severe Adult Mental Illness

ScienceDaily.com

Working with mice, Johns Hopkins researchers have established a link between elevated levels of a stress hormone in adolescence — a critical time for brain development — and genetic changes that, in young adulthood, cause severe mental illness in those predisposed to it.

The findings, reported in the journal Science, could have wide-reaching implications in both the prevention and treatment of schizophrenia, severe depression and other mental illnesses.

We have discovered a mechanism for how environmental factors, such as stress hormones, can affect the brain’s physiology and bring about mental illness,” says study leader Akira Sawa, M.D., Ph.D., a professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine. “We’ve shown in mice that stress in adolescence can affect the expression of a gene that codes for a key neurotransmitter related to mental function and psychiatric illness. While many genes are believed to be involved in the development of mental illness, my gut feeling is environmental factors are critically important to the process.”

Sawa, director of the Johns Hopkins Schizophrenia Center, and his team set out to simulate social isolation associated with the difficult years of adolescents in human teens. They found that isolating healthy mice from other mice for three weeks during the equivalent of rodent adolescence had no effect on their behavior. But, when mice known to have a genetic predisposition to characteristics of mental illness were similarly isolated, they exhibited behaviors associated with mental illness, such as hyperactivity. They also failed to swim when put in a pool, an indirect correlate of human depression. When the isolated mice with genetic risk factors for mental illness were returned to group housing with other mice, they continued to exhibit these abnormal behaviors, a finding that suggests the effects of isolation lasted into the equivalent of adulthood.

Genetic risk factors in these experiments were necessary, but not sufficient, to cause behaviors associated with mental illness in mice,” Sawa says. “Only the addition of the external stressor — in this case, excess cortisol related to social isolation — was enough to bring about dramatic behavior changes.”

The investigators not only found that the “mentally ill” mice had elevated levels of cortisol, known as the stress hormone because it’s secreted in higher levels during the body’s fight-or-flight response. They also found that these mice had significantly lower levels of the neurotransmitter dopamine in a specific region of the brain involved in higher brain function, such as emotional control and cognition. Changes in dopamine in the brains of patients with schizophrenia, depression and mood disorders have been suggested in clinical studies, but the mechanism for the clinical impact remains elusive.

To determine whether cortisol levels were influencing dopamine levels in the brain and adult behavioral patterns in the abnormal mice, the investigators gave them a compound called RU486, known to block cells from receiving cortisol. (The drug is commonly known as the “abortion pill.”) All symptoms subsided. RU486 has also been studied in a clinical trial of people with difficult-to-treat psychotic depression, showing some benefits. “The mice swam longer, they were less hyper and their dopamine levels normalized,” Sawa says.

To shed light on how and why the mice got better, Sawa and his team studied the gene tyrosine hydroxylase (Th) and found an epigenetic change, essentially the addition of a methyl group to one of the gene’s DNA letters, limiting the gene’s ability to do its job, which is to create an enzyme that regulates dopamine levels. Without a fully functioning Th, dopamine levels are abnormally low.

Scientists have long studied gene mutations, permanent DNA changes that can tweak the normal function of a particular gene. But epigenetic alterations do not change the actual letters of the DNA sequence. Instead, they add a chemical group like methyl that can affect the function of the DNA. These changes can be transient, whereas genetic mutations are permanent.

Sawa says the new study points to the need to think about better preventive care in teenagers who have mental illness in their families, including efforts to protect them from social stressors, such as neglect. Meanwhile, by understanding the cascade of events that occurs when cortisol levels are elevated, researchers may be able to develop new compounds to target tough-to-treat psychiatric disorders with fewer side effects than RU486 has.

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[Article of Interest] Some Observations of Soteria-Alaska
By Daniel Mackler
I write this piece from Anchorage, Alaska, where I am presently filling in as the executive director of Soteria-Alaska while their founding executive director, Susan Musante, is on sabbatical.  Soteria-Alaska, a program designed to follow Loren Mosher’s California Soteria model from the 1970s and early 1980s, has been up and running for the past three years.  Soteria-Alaska is a house, staffed around-the-clock with gentle, open-minded nonprofessionals, with five beds for people experiencing psychosis.  The basic idea is that people can live in the house for about six months or so, give or take, in order to work through or pass through their psychosis with little or preferably no psychiatric medication.  Soteria-Alaska is a largely state- and grant-funded program open primarily to Alaska residents, for whom, if they are low-income, it is free.

In this article I will explore the work Soteria-Alaska does with clients — known as residents — and assess the quality and success of this work.  But first I will provide a little background.  Loren Mosher, a psychiatrist who was the Chief of the Center for Studies of Schizophrenia at the National Institute of Mental Health, designed the original Soteria Project as an alternative to hospitalization for people experiencing a first-time psychotic crisis — one of the variety that would traditionally be treated with a locked ward, neuroleptics, a likelihood of restraints, and an eventual diagnosis of schizophrenia.  All too often this traditional path resulted, and still results, in a lifetime of psychiatric disability, which the system considers normal, which is why it so often tells people experiencing psychosis for the first time that they need to “accept their illness,” “take their drugs for life,” and the like.  However, the original Soteria House in San Jose, California put this idea to shame.  Some sixty to seventy percent of its residents — all of whom, in the first several years of the program’s existence, came straight from San Jose’s local psychiatric emergency room — recovered fully.  They moved on to productive, non-disabled lives, returning to school, getting jobs, and leaving mental health treatment and psychosis behind.

Soteria-Alaska was founded by Jim Gottstein, an Alaskan psychiatric survivor and Harvard lawyer who recognized Anchorage’s need for a similar hospital diversion program.  Prior to the creation of Soteria-Alaska, there were no alternatives to hospitalization in Anchorage (or, for that matter, almost anywhere in the United States) that promoted the idea of full recovery without medication.  Jim, along with others, created Soteria-Alaska with a clear vision of helping people recover fully.  The main hurdle in implementing this, however, has been figuring out how to integrate a program with this vision into the mainstream biopsychiatric mental health system of Anchorage, which relies on heavy pharmaceutical interventions for its primary lines of defense.  Most programs and treatment providers in Anchorage, as in the rest of the United States, don’t consider as relevant the concepts upon which Soteria is based, and may even think them dangerous or harmful.

The basic model of Soteria is a sort of “live-and-let-live” philosophy — one of “being with,” not “doing to.”  Philosophically, Soteria avoids forcing or pressuring anyone to do anything.  By conventional standards, one could argue that Soteria is not really even “treatment,” per se, rather, a program which gets out of people’s way and gives them the respect and freedom to go through their process on their own, albeit with the emotional support of others.  Soteria views psychosis as a sort of crisis or emergency that is laden with meaning, and that people can derive value from their crisis while living in a community of respectful, caring, intuitive others.  This really is a radically different model, concept, and philosophy than that of mainstream biomedical psychiatry.  Yet the rub is that Soteria-Alaska, like the original California Soteria, gets its referrals from within the biomedical psychiatric system.  So basically Soteria contradicts, but nevertheless has to get along with, the traditional mental health system.  This is no small challenge.

This has affected the manifestation of Soteria-Alaska’s vision.  The main area of drift from the vision is that Soteria-Alaska hasn’t ended up working with the type of people for whom it was designed to help.  Instead, for a variety of reasons, Soteria has worked almost exclusively with people who are more “chronic” psychiatric patients, that is, people who, to varying degrees, have been in the psychiatric system for some time, have been exposed, in many cases for years, to psychiatric drugs (such as neuroleptics, mood stabilizers, antidepressants, and the like — and often combinations of them), have been psychiatrically hospitalized (sometimes multiple times), and may even be on government disability upon admission to the house.  This is quite a departure from the original Soteria model, because compared with people experiencing a first psychotic break, “chronic” patients generally have far more serious, intractable, and complex problems, and as the result tend to be far harder to help.

Because of this, Soteria-Alaska, from the information I have gathered, has not experienced good recovery rates — insofar as Mosher’s original Soteria definition of recovery involved people getting and staying out of the mental health system and living independently in the community (and, I would also add, becoming employed or returning to school).  Yet this is not to say that Soteria-Alaska has not had profound value as a program, or, like the California Soteria, as an experiment.  First let me address the value of both Soterias as experiments.  The California Soteria showed, beyond a doubt, and revolutionarily so, that people experiencing a first psychotic episode did far better living in an unstructured, homelike, protected, gentle, non-coercive house with other residents like themselves and with a staff picked for their interpersonal qualities and their lack of psychiatric training than did similar people if they received traditional psychiatric treatment.

The Soteria-Alaska experiment has, thus far, been a different one.  The experiment here, though not formally defined as such, has, to my mind, been to see if a house structured and staffed quite similarly to the original California Soteria House would be effective in helping chronic mental patients get fully out of psychiatry.  And, like any good experiment, a clear negative answer is just as good as a clear positive answer, which is why I consider this part of the Soteria-Alaska experiment to be a valid one, because I consider the answer to be clear:  Soteria as a program is not successful in helping catalyze the full recovery of chronic mental patients.  That said, it has been successful in catalyzing the partial recovery of several residents, beyond any expectation of traditional mental health.  Nevertheless, it has not yet proven itself, in its first three years, at promoting any full recoveries in line with the original Soteria definition.  Thus, my conclusion:  Soteria is not a one-size-fits-all program for clients.

To backtrack, though, I would like to address the thread regarding the help it has provided people.  Soteria-Alaska, after all, has been incredibly valuable to many, if not most, of its residents — even the most “chronic” ones.  Many people have grown with the help of Soteria-Alaska — even in spite of the 2011 shooting of a former resident by another former resident on the grounds of Soteria.  Overall, almost all residents at Soteria-Alaska have had a chance to experience freedom to make their own choices, to experience respect by the staff, to participate in a curious and welcoming community, to engage in healthy decision-making, to have healthy meals and healthy fun, to experience liberty to feel their own feelings, and to experience the opportunity to fall down — sometimes pretty hard — and to get back up again.  Also, many residents have gotten the invaluable chance to explore and express the limits of their nontraditional behavior in a way that almost no other mental health program I have ever witnessed would tolerate — let alone for such a long period of time.  As the result, many residents have matured profoundly as the result of their time at Soteria.  And at least one Soteria resident even came fully out of a profound psychosis, off-medication, during the resident’s stay at the house.

In no small part I credit their founding executive director, Susan Musante, for this.  She has fostered a community of staff, residents, former residents, volunteers, allies, and a board of directors who are passionate about the Soteria mission.  Her gift with people has nurtured something truly special — something which drew me to visit in 2011 and drew me back again now.  She has set a standard for authenticity and respect for personal choice that is rare in the modern mental health field.  And it permeates the Soteria climate.  The Soteria-Alaska staff are some of the most flexible, respectful people I have had the chance to work with.  And so many of the residents with whom I have interacted, even ones who left Soteria in rage or anger or resentment or crisis, note this — and note the value they received from this.  For many it has been the first time in their lives where they found a place that accepted them as they were and welcomed their evolving, and often terrifying, processes.  I myself have gotten to speak with several former residents about this, because they phone Soteria all the time and just want to talk.  Soteria is a place, and often one of the only places in their lives, where they feel safe to do that.

But I realized not long after I began my job here that the way Soteria-Alaska has manifested has come at a major price.  For starters, it can be extremely taxing on the staff.  It is not easy for them to interact so intensely, intimately, and authentically with chronically psychiatrized and institutionalized people, especially when these residents are coming off their psychiatric drugs and discovering their abilities to express themselves with almost entire freedom.  Staff burnout has been a serious issue here.  I would have to say that working at Soteria-Alaska is not a job I would reasonably expect someone to be able to do for a long period of time:  perhaps a few years at the most.  The reason, as I hypothesized to the staff shortly after I arrived, and to which they concurred, is that because they were working with chronic mental patients as opposed to people experiencing first psychotic breaks, yet holding nevertheless to the same Soteria goals of full recovery, they were working far harder for far less promising results.

Full recovery by a resident is a major boost for everyone because it sends positive shockwaves throughout the community.  It restores all of our hope — and reminds us that this seemingly mysterious thing called psychosis is just another normal human phenomenon through which we can pass and come out the other side, and even come out stronger and wiser.  But if people are not coming out the other side, or at best very rarely do to a full degree, who can expect people, especially long-time staff, to remain hopeful?  Partial recoveries partially boost hope, but not nearly to the same degree as full recoveries.  Thus, if staff don’t see full recovery, and especially if they don’t see it on a regular basis (which happened at the original Soteria House), they risk becoming demoralized and starting to think of psychosis not as episodic but as chronic.

That, as far as I can see, is the result of what the traditional mental health system’s near ubiquity has done to our perspective.  Once people spend increasing amounts of time in the system and on these drugs, especially the heavy ones in the combinations so presently prescribed, their actual likelihood of pulling fully out of chronic patienthood goes way down.  My experience as a therapist has shown me this loud and clear, and Robert Whitaker’s book “Anatomy of an Epidemic” outlines this same phenomenon from a scientific perspective.  My belief is that full recovery is just too difficult to achieve for many chronic mental patients unless they have a program working for them that is a lot more intensive and structured than Soteria.  Also, from what I have read, the people who end up heavily polymedicated for long periods of time have had their brains — and I use this word carefully, because I am not referring to their minds here — profoundly affected by these drugs.  It seems to me that so many of these people have their own special, individualized versions of traumatic brain injury.  And, in general, many need a lot more help than just love and kindness and respect and compassion of the Loren Mosher Soteria variety.

In this vein, Soteria was not really designed to be a medication withdrawal program.  Medication withdrawal, even with only one resident withdrawing at a time, risks being simply too intense for a Soteria environment to handle, and even more so when we envision several people simultaneously going through drug withdrawal and a consequential rebound psychosis.  Soteria’s work is hard enough; the drug withdrawal component, in my opinion, makes it just too hard.  And converting Soteria into a successful drug withdrawal program would, in my opinion, require that Soteria sacrifice so much of its basic philosophy and character that its very Soteria nature would most likely be undone.

For that reason, my primary goal during my short tenure at Soteria-Alaska has been to try to connect Soteria with the residents for whom it was designed:  people experiencing a first psychotic episode.  This is easier said than done — which, to be fair, is what everyone told me when I arrived.  Some even told me that such people no longer existed, because, according to them, most everyone with “problems” in Alaska gets medicated, to one degree or other, in childhood nowadays.  But I didn’t entirely believe this — because I have met some adults in Alaska experiencing first breaks, heard stories of many others, and also met recovered people here who themselves passed through unmedicated first breaks.

As I see it, the main hope for Soteria-Alaska, if it wishes to hold to the original Soteria model and remain a sustainable, nonintrusive, non-coercive, unstructured, freedom-respecting program that shifts its course toward getting robust recovery rates from psychosis, is to forge a strong, ongoing, positive relationship with Anchorage’s local psychiatric emergency room and create a way to assist them in diverting at least some percentage of their patients experiencing a first psychotic episode away from traditional psychiatry and toward us.  (I actually think an intimate connection with the local psychiatric emergency room would prove key to the success of almost any program that aspires to help people in first psychotic episodes.) I, along with Soteria’s directing clinician, have been working at developing this relationship with the emergency room staff, and so far, surprisingly, have been watching it blossom.

There have been some problems developing this relationship, though.  One main one is that that they have, for some time, held a generally negative view of Soteria-Alaska.  Their negativity seems to have arisen because their most primal contact with us has come from meeting some of our most conflicted residents when they are at their most troubled:  when they have left Soteria, are in a state of florid rebound psychosis from medication withdrawal, and have returned, often against their will, to the psychiatric emergency room.  Their staff also know the story of the 2011 shooting at Soteria, because it made all the local news.  So they have looked at Soteria through a skeptical lens.  And, from their perspective (even if I hold a different one), why wouldn’t they?  They see their job as to help stabilize psychosis with medication, and they see us doing the exact opposite.  Also, if Soteria were really helping many people recover fully, the psychiatric emergency room would be referring people to us, and not us to them.  Thus, I have been focused on changing the direction of that one-way street sign.

What made me hopeful that this was possible was that even though, in my first month at Soteria, the psychiatric emergency room staff held a negatively tinged view about us, they remained open to referring to us.  I found this curious, and I recently had the chance to ask one of their clinicians why this was.

Her answer, which I will paraphrase:  “We’re just doing our best here, we’re often overwhelmed with intakes, and we have so few resources aside from medication and hospitalization.  And some people who come to us really don’t want to take meds — and we don’t want to force people to do things against their wills, especially if they really don’t seem to be a danger to themselves or others.  So Soteria, if it really might be able to help some people, could be a resource — and we want to consider it.”

This made me hopeful.  But, as far as I saw, it also meant that Soteria-Alaska had to change some of its ways.  We had to make the house a safer, more respectful, more welcoming place for people experiencing first-episode psychosis.  In some ways Soteria-Alaska, as it was manifested when I arrived, was not always so welcoming.  Chronic mental patients, especially if they were coming off heavy, long-prescribed psychiatric drugs, could be very disruptive to the atmosphere of the house for a very long, and even seemingly indefinite, period of time.  I know that the original Soteria House in California worked with a lot of people who could be disruptive (window-smashing, violence, etc.), but it’s my understanding that these disruptions, however major, didn’t usually last that long:  they were measured more in days, perhaps several weeks.  At Soteria-Alaska these disruptions, including episodes of ongoing violence, destructive of property, threatening behavior, and, not least of all wild, super-intense, and very difficult-to-reach rebound psychosis, could last for endless months — and if given a chance, could last even longer.  This can have a serious negative impact on others’ recovery.

For this reason, I suggested and the staff agreed that for the first couple of months of my tenure here we only accept new residents who are experiencing a first psychotic break, or at the least something very close to it.  This was a high-pressure plan, as it entered us into a waiting game:  to see if we could build a relationship with the local psychiatric emergency room, and perhaps with other potential referral sources, like the local universities’ counseling services, quickly enough to find appropriate residents before we ran out of financial resources.

Yet, as I noted, things, at least preliminarily, have begun to blossom for us.  In the last month the psychiatric emergency room has sent us one person whose life situation rather closely fit within the criteria of our mission and another whose situation fit it perfectly.  Also, five weeks ago the local psychiatric hospital, with whom we also shared our new, clearly-defined mission, referred us another person who was very close to meeting our mission’s criteria, though this person had been on neuroleptic medications for a few days.  We accepted all of these young people, and so far they have all been living successfully at Soteria.  It is too soon to know exactly how Soteria will work for them, but so far one thing is clear:  it’s not not working!

Regarding these three new residents, one other key thing that I have observed is that none of them has been going through something so commonly experienced by past residents of Soteria-Alaska:  severe psychiatric drug withdrawal.  And all three of these new residents stopped taking their psychiatric medications by choice.  The two residents who came from the psychiatric emergency room had been on a neuroleptic for less than two days, and because of that had no noticeable effects from stopping taking it at Soteria.  The other resident, who had been taking a neuroleptic for slightly less than a week, experienced some disturbed sleep from stopping the drug — which the resident tapered, with our consultant psychiatrist’s supervision, over several days — but little else.

So in some ways we at Soteria have been feeling much less pressure — and much more hope.  We now know that the psychiatric emergency room staff are willing send us people whom they feel are appropriate for our services.  This is, to say the least, extremely exciting.  I must admit that I didn’t feel overly optimistic about this two months ago, before we had any residents in our house who fit our mission criteria, because it was by no means assured that the emergency room staff, or anyone, would ever send us anyone appropriate.  And I shuddered to consider what would have happened if no one connected us with anyone appropriate.  Would we go back to square one?  Would we have to change our program dramatically to accommodate a more psychiatrically chronic type of resident?  Would we have to contract with potential residents that one condition for staying at Soteria involved them agreeing to stay on their medications?

At the time, I brought up this final possibility with several staff members at Soteria and to a person they all said that if people were required to stay on their psychiatric drugs as a requirement for residency at Soteria then they would quit their jobs.

I heard:  “I couldn’t work at a place like that.”

And:  “I would lose my heart for this work.”

And:  “That goes against what I stand for.  People need to be free to choose their life path.”

And I don’t disagree.  But as I replied to them:  “Then we need to make sure we continue to work with people whom we can actually help, and really not take on people who are chronically disabled by psychiatry and institutions.”

They agreed.  Thus, the challenge remains — but at least now we have a bit more hope, and can see a bit more light at the end of the tunnel.

Meanwhile, we have used the new opportunities provided to us to strengthen our bond with the local mental health practitioners.  We have shared our early successes with them, and they have made it clear to us that they wish us — that is, they wish the residents they sent our way — to succeed.

And to me this signals a whole new area of hope, on a broader societal level, for the following reason:  if people who work in mainstream biological psychiatry are willing to consider referring people in severe psychiatric crises to a program that operates under both a completely alternative philosophy and model to their own, then I see hope for our world’s mental health system.  If our local psychiatric emergency room is willing to refer to a program like ours, then other psychiatric emergency rooms elsewhere in the United States and the world must be willing at least to consider doing the same.  For this reason, I do not feel like Don Quixote tilting at windmills.  I feel the system can change.

But the first thing we, and other programs like ours, need to do is to document our results and show people that these alternative programs can and do actually work.  We also need to be honest with ourselves about who we can help and who we can’t, and then we need give it our all to try to help those we can.  And for those we feel we will be less likely to help, we need to look seriously into creating programs that will realistically and practically help them.

But the bottom line is that we need to keep building on our successes.  This is the recipe for future hope.

[Article of Interest] Some Observations of Soteria-Alaska

By Daniel Mackler

I write this piece from Anchorage, Alaska, where I am presently filling in as the executive director of Soteria-Alaska while their founding executive director, Susan Musante, is on sabbatical.  Soteria-Alaska, a program designed to follow Loren Mosher’s California Soteria model from the 1970s and early 1980s, has been up and running for the past three years.  Soteria-Alaska is a house, staffed around-the-clock with gentle, open-minded nonprofessionals, with five beds for people experiencing psychosis.  The basic idea is that people can live in the house for about six months or so, give or take, in order to work through or pass through their psychosis with little or preferably no psychiatric medication.  Soteria-Alaska is a largely state- and grant-funded program open primarily to Alaska residents, for whom, if they are low-income, it is free.

In this article I will explore the work Soteria-Alaska does with clients — known as residents — and assess the quality and success of this work.  But first I will provide a little background.  Loren Mosher, a psychiatrist who was the Chief of the Center for Studies of Schizophrenia at the National Institute of Mental Health, designed the original Soteria Project as an alternative to hospitalization for people experiencing a first-time psychotic crisis — one of the variety that would traditionally be treated with a locked ward, neuroleptics, a likelihood of restraints, and an eventual diagnosis of schizophrenia.  All too often this traditional path resulted, and still results, in a lifetime of psychiatric disability, which the system considers normal, which is why it so often tells people experiencing psychosis for the first time that they need to “accept their illness,” “take their drugs for life,” and the like.  However, the original Soteria House in San Jose, California put this idea to shame.  Some sixty to seventy percent of its residents — all of whom, in the first several years of the program’s existence, came straight from San Jose’s local psychiatric emergency room — recovered fully.  They moved on to productive, non-disabled lives, returning to school, getting jobs, and leaving mental health treatment and psychosis behind.

Soteria-Alaska was founded by Jim Gottstein, an Alaskan psychiatric survivor and Harvard lawyer who recognized Anchorage’s need for a similar hospital diversion program.  Prior to the creation of Soteria-Alaska, there were no alternatives to hospitalization in Anchorage (or, for that matter, almost anywhere in the United States) that promoted the idea of full recovery without medication.  Jim, along with others, created Soteria-Alaska with a clear vision of helping people recover fully.  The main hurdle in implementing this, however, has been figuring out how to integrate a program with this vision into the mainstream biopsychiatric mental health system of Anchorage, which relies on heavy pharmaceutical interventions for its primary lines of defense.  Most programs and treatment providers in Anchorage, as in the rest of the United States, don’t consider as relevant the concepts upon which Soteria is based, and may even think them dangerous or harmful.

The basic model of Soteria is a sort of “live-and-let-live” philosophy — one of “being with,” not “doing to.”  Philosophically, Soteria avoids forcing or pressuring anyone to do anything.  By conventional standards, one could argue that Soteria is not really even “treatment,” per se, rather, a program which gets out of people’s way and gives them the respect and freedom to go through their process on their own, albeit with the emotional support of others.  Soteria views psychosis as a sort of crisis or emergency that is laden with meaning, and that people can derive value from their crisis while living in a community of respectful, caring, intuitive others.  This really is a radically different model, concept, and philosophy than that of mainstream biomedical psychiatry.  Yet the rub is that Soteria-Alaska, like the original California Soteria, gets its referrals from within the biomedical psychiatric system.  So basically Soteria contradicts, but nevertheless has to get along with, the traditional mental health system.  This is no small challenge.

This has affected the manifestation of Soteria-Alaska’s vision.  The main area of drift from the vision is that Soteria-Alaska hasn’t ended up working with the type of people for whom it was designed to help.  Instead, for a variety of reasons, Soteria has worked almost exclusively with people who are more “chronic” psychiatric patients, that is, people who, to varying degrees, have been in the psychiatric system for some time, have been exposed, in many cases for years, to psychiatric drugs (such as neuroleptics, mood stabilizers, antidepressants, and the like — and often combinations of them), have been psychiatrically hospitalized (sometimes multiple times), and may even be on government disability upon admission to the house.  This is quite a departure from the original Soteria model, because compared with people experiencing a first psychotic break, “chronic” patients generally have far more serious, intractable, and complex problems, and as the result tend to be far harder to help.

Because of this, Soteria-Alaska, from the information I have gathered, has not experienced good recovery rates — insofar as Mosher’s original Soteria definition of recovery involved people getting and staying out of the mental health system and living independently in the community (and, I would also add, becoming employed or returning to school).  Yet this is not to say that Soteria-Alaska has not had profound value as a program, or, like the California Soteria, as an experiment.  First let me address the value of both Soterias as experiments.  The California Soteria showed, beyond a doubt, and revolutionarily so, that people experiencing a first psychotic episode did far better living in an unstructured, homelike, protected, gentle, non-coercive house with other residents like themselves and with a staff picked for their interpersonal qualities and their lack of psychiatric training than did similar people if they received traditional psychiatric treatment.

The Soteria-Alaska experiment has, thus far, been a different one.  The experiment here, though not formally defined as such, has, to my mind, been to see if a house structured and staffed quite similarly to the original California Soteria House would be effective in helping chronic mental patients get fully out of psychiatry.  And, like any good experiment, a clear negative answer is just as good as a clear positive answer, which is why I consider this part of the Soteria-Alaska experiment to be a valid one, because I consider the answer to be clear:  Soteria as a program is not successful in helping catalyze the full recovery of chronic mental patients.  That said, it has been successful in catalyzing the partial recovery of several residents, beyond any expectation of traditional mental health.  Nevertheless, it has not yet proven itself, in its first three years, at promoting any full recoveries in line with the original Soteria definition.  Thus, my conclusion:  Soteria is not a one-size-fits-all program for clients.

To backtrack, though, I would like to address the thread regarding the help it has provided people.  Soteria-Alaska, after all, has been incredibly valuable to many, if not most, of its residents — even the most “chronic” ones.  Many people have grown with the help of Soteria-Alaska — even in spite of the 2011 shooting of a former resident by another former resident on the grounds of Soteria.  Overall, almost all residents at Soteria-Alaska have had a chance to experience freedom to make their own choices, to experience respect by the staff, to participate in a curious and welcoming community, to engage in healthy decision-making, to have healthy meals and healthy fun, to experience liberty to feel their own feelings, and to experience the opportunity to fall down — sometimes pretty hard — and to get back up again.  Also, many residents have gotten the invaluable chance to explore and express the limits of their nontraditional behavior in a way that almost no other mental health program I have ever witnessed would tolerate — let alone for such a long period of time.  As the result, many residents have matured profoundly as the result of their time at Soteria.  And at least one Soteria resident even came fully out of a profound psychosis, off-medication, during the resident’s stay at the house.

In no small part I credit their founding executive director, Susan Musante, for this.  She has fostered a community of staff, residents, former residents, volunteers, allies, and a board of directors who are passionate about the Soteria mission.  Her gift with people has nurtured something truly special — something which drew me to visit in 2011 and drew me back again now.  She has set a standard for authenticity and respect for personal choice that is rare in the modern mental health field.  And it permeates the Soteria climate.  The Soteria-Alaska staff are some of the most flexible, respectful people I have had the chance to work with.  And so many of the residents with whom I have interacted, even ones who left Soteria in rage or anger or resentment or crisis, note this — and note the value they received from this.  For many it has been the first time in their lives where they found a place that accepted them as they were and welcomed their evolving, and often terrifying, processes.  I myself have gotten to speak with several former residents about this, because they phone Soteria all the time and just want to talk.  Soteria is a place, and often one of the only places in their lives, where they feel safe to do that.

But I realized not long after I began my job here that the way Soteria-Alaska has manifested has come at a major price.  For starters, it can be extremely taxing on the staff.  It is not easy for them to interact so intensely, intimately, and authentically with chronically psychiatrized and institutionalized people, especially when these residents are coming off their psychiatric drugs and discovering their abilities to express themselves with almost entire freedom.  Staff burnout has been a serious issue here.  I would have to say that working at Soteria-Alaska is not a job I would reasonably expect someone to be able to do for a long period of time:  perhaps a few years at the most.  The reason, as I hypothesized to the staff shortly after I arrived, and to which they concurred, is that because they were working with chronic mental patients as opposed to people experiencing first psychotic breaks, yet holding nevertheless to the same Soteria goals of full recovery, they were working far harder for far less promising results.

Full recovery by a resident is a major boost for everyone because it sends positive shockwaves throughout the community.  It restores all of our hope — and reminds us that this seemingly mysterious thing called psychosis is just another normal human phenomenon through which we can pass and come out the other side, and even come out stronger and wiser.  But if people are not coming out the other side, or at best very rarely do to a full degree, who can expect people, especially long-time staff, to remain hopeful?  Partial recoveries partially boost hope, but not nearly to the same degree as full recoveries.  Thus, if staff don’t see full recovery, and especially if they don’t see it on a regular basis (which happened at the original Soteria House), they risk becoming demoralized and starting to think of psychosis not as episodic but as chronic.

That, as far as I can see, is the result of what the traditional mental health system’s near ubiquity has done to our perspective.  Once people spend increasing amounts of time in the system and on these drugs, especially the heavy ones in the combinations so presently prescribed, their actual likelihood of pulling fully out of chronic patienthood goes way down.  My experience as a therapist has shown me this loud and clear, and Robert Whitaker’s book “Anatomy of an Epidemic” outlines this same phenomenon from a scientific perspective.  My belief is that full recovery is just too difficult to achieve for many chronic mental patients unless they have a program working for them that is a lot more intensive and structured than Soteria.  Also, from what I have read, the people who end up heavily polymedicated for long periods of time have had their brains — and I use this word carefully, because I am not referring to their minds here — profoundly affected by these drugs.  It seems to me that so many of these people have their own special, individualized versions of traumatic brain injury.  And, in general, many need a lot more help than just love and kindness and respect and compassion of the Loren Mosher Soteria variety.

In this vein, Soteria was not really designed to be a medication withdrawal program.  Medication withdrawal, even with only one resident withdrawing at a time, risks being simply too intense for a Soteria environment to handle, and even more so when we envision several people simultaneously going through drug withdrawal and a consequential rebound psychosis.  Soteria’s work is hard enough; the drug withdrawal component, in my opinion, makes it just too hard.  And converting Soteria into a successful drug withdrawal program would, in my opinion, require that Soteria sacrifice so much of its basic philosophy and character that its very Soteria nature would most likely be undone.

For that reason, my primary goal during my short tenure at Soteria-Alaska has been to try to connect Soteria with the residents for whom it was designed:  people experiencing a first psychotic episode.  This is easier said than done — which, to be fair, is what everyone told me when I arrived.  Some even told me that such people no longer existed, because, according to them, most everyone with “problems” in Alaska gets medicated, to one degree or other, in childhood nowadays.  But I didn’t entirely believe this — because I have met some adults in Alaska experiencing first breaks, heard stories of many others, and also met recovered people here who themselves passed through unmedicated first breaks.

As I see it, the main hope for Soteria-Alaska, if it wishes to hold to the original Soteria model and remain a sustainable, nonintrusive, non-coercive, unstructured, freedom-respecting program that shifts its course toward getting robust recovery rates from psychosis, is to forge a strong, ongoing, positive relationship with Anchorage’s local psychiatric emergency room and create a way to assist them in diverting at least some percentage of their patients experiencing a first psychotic episode away from traditional psychiatry and toward us.  (I actually think an intimate connection with the local psychiatric emergency room would prove key to the success of almost any program that aspires to help people in first psychotic episodes.) I, along with Soteria’s directing clinician, have been working at developing this relationship with the emergency room staff, and so far, surprisingly, have been watching it blossom.

There have been some problems developing this relationship, though.  One main one is that that they have, for some time, held a generally negative view of Soteria-Alaska.  Their negativity seems to have arisen because their most primal contact with us has come from meeting some of our most conflicted residents when they are at their most troubled:  when they have left Soteria, are in a state of florid rebound psychosis from medication withdrawal, and have returned, often against their will, to the psychiatric emergency room.  Their staff also know the story of the 2011 shooting at Soteria, because it made all the local news.  So they have looked at Soteria through a skeptical lens.  And, from their perspective (even if I hold a different one), why wouldn’t they?  They see their job as to help stabilize psychosis with medication, and they see us doing the exact opposite.  Also, if Soteria were really helping many people recover fully, the psychiatric emergency room would be referring people to us, and not us to them.  Thus, I have been focused on changing the direction of that one-way street sign.

What made me hopeful that this was possible was that even though, in my first month at Soteria, the psychiatric emergency room staff held a negatively tinged view about us, they remained open to referring to us.  I found this curious, and I recently had the chance to ask one of their clinicians why this was.

Her answer, which I will paraphrase:  “We’re just doing our best here, we’re often overwhelmed with intakes, and we have so few resources aside from medication and hospitalization.  And some people who come to us really don’t want to take meds — and we don’t want to force people to do things against their wills, especially if they really don’t seem to be a danger to themselves or others.  So Soteria, if it really might be able to help some people, could be a resource — and we want to consider it.”

This made me hopeful.  But, as far as I saw, it also meant that Soteria-Alaska had to change some of its ways.  We had to make the house a safer, more respectful, more welcoming place for people experiencing first-episode psychosis.  In some ways Soteria-Alaska, as it was manifested when I arrived, was not always so welcoming.  Chronic mental patients, especially if they were coming off heavy, long-prescribed psychiatric drugs, could be very disruptive to the atmosphere of the house for a very long, and even seemingly indefinite, period of time.  I know that the original Soteria House in California worked with a lot of people who could be disruptive (window-smashing, violence, etc.), but it’s my understanding that these disruptions, however major, didn’t usually last that long:  they were measured more in days, perhaps several weeks.  At Soteria-Alaska these disruptions, including episodes of ongoing violence, destructive of property, threatening behavior, and, not least of all wild, super-intense, and very difficult-to-reach rebound psychosis, could last for endless months — and if given a chance, could last even longer.  This can have a serious negative impact on others’ recovery.

For this reason, I suggested and the staff agreed that for the first couple of months of my tenure here we only accept new residents who are experiencing a first psychotic break, or at the least something very close to it.  This was a high-pressure plan, as it entered us into a waiting game:  to see if we could build a relationship with the local psychiatric emergency room, and perhaps with other potential referral sources, like the local universities’ counseling services, quickly enough to find appropriate residents before we ran out of financial resources.

Yet, as I noted, things, at least preliminarily, have begun to blossom for us.  In the last month the psychiatric emergency room has sent us one person whose life situation rather closely fit within the criteria of our mission and another whose situation fit it perfectly.  Also, five weeks ago the local psychiatric hospital, with whom we also shared our new, clearly-defined mission, referred us another person who was very close to meeting our mission’s criteria, though this person had been on neuroleptic medications for a few days.  We accepted all of these young people, and so far they have all been living successfully at Soteria.  It is too soon to know exactly how Soteria will work for them, but so far one thing is clear:  it’s not not working!

Regarding these three new residents, one other key thing that I have observed is that none of them has been going through something so commonly experienced by past residents of Soteria-Alaska:  severe psychiatric drug withdrawal.  And all three of these new residents stopped taking their psychiatric medications by choice.  The two residents who came from the psychiatric emergency room had been on a neuroleptic for less than two days, and because of that had no noticeable effects from stopping taking it at Soteria.  The other resident, who had been taking a neuroleptic for slightly less than a week, experienced some disturbed sleep from stopping the drug — which the resident tapered, with our consultant psychiatrist’s supervision, over several days — but little else.

So in some ways we at Soteria have been feeling much less pressure — and much more hope.  We now know that the psychiatric emergency room staff are willing send us people whom they feel are appropriate for our services.  This is, to say the least, extremely exciting.  I must admit that I didn’t feel overly optimistic about this two months ago, before we had any residents in our house who fit our mission criteria, because it was by no means assured that the emergency room staff, or anyone, would ever send us anyone appropriate.  And I shuddered to consider what would have happened if no one connected us with anyone appropriate.  Would we go back to square one?  Would we have to change our program dramatically to accommodate a more psychiatrically chronic type of resident?  Would we have to contract with potential residents that one condition for staying at Soteria involved them agreeing to stay on their medications?

At the time, I brought up this final possibility with several staff members at Soteria and to a person they all said that if people were required to stay on their psychiatric drugs as a requirement for residency at Soteria then they would quit their jobs.

I heard:  “I couldn’t work at a place like that.”

And:  “I would lose my heart for this work.”

And:  “That goes against what I stand for.  People need to be free to choose their life path.”

And I don’t disagree.  But as I replied to them:  “Then we need to make sure we continue to work with people whom we can actually help, and really not take on people who are chronically disabled by psychiatry and institutions.”

They agreed.  Thus, the challenge remains — but at least now we have a bit more hope, and can see a bit more light at the end of the tunnel.

Meanwhile, we have used the new opportunities provided to us to strengthen our bond with the local mental health practitioners.  We have shared our early successes with them, and they have made it clear to us that they wish us — that is, they wish the residents they sent our way — to succeed.

And to me this signals a whole new area of hope, on a broader societal level, for the following reason:  if people who work in mainstream biological psychiatry are willing to consider referring people in severe psychiatric crises to a program that operates under both a completely alternative philosophy and model to their own, then I see hope for our world’s mental health system.  If our local psychiatric emergency room is willing to refer to a program like ours, then other psychiatric emergency rooms elsewhere in the United States and the world must be willing at least to consider doing the same.  For this reason, I do not feel like Don Quixote tilting at windmills.  I feel the system can change.

But the first thing we, and other programs like ours, need to do is to document our results and show people that these alternative programs can and do actually work.  We also need to be honest with ourselves about who we can help and who we can’t, and then we need give it our all to try to help those we can.  And for those we feel we will be less likely to help, we need to look seriously into creating programs that will realistically and practically help them.

But the bottom line is that we need to keep building on our successes.  This is the recipe for future hope.

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[Article of Interest] I Was Adam Lanza
By David Frum
Recently, the Huffington Post published an article titled “I am Adam Lanza’s mother” by a woman named Liza Long. The article presents a picture of a 13-year-old boy who threatened his mother, sometimes going so far as to pull a knife on her, scream obscenities at her, and leap out of cars as they’re driving down the highway.
The rest of the world has reacted to the idea of such a child with horror and incomprehension. I sympathize with the horror. I can only wish that I shared the incomprehension. I understand, intimately, how Liza Long’s son feels. I was like him.
Like the author of that piece, Liza Long, my mother had no idea what to do about my sudden transformation (in my case, around 16) into a borderline homicidal maniac. Like her son, I used knives to try and make my threats of violence seem more real. Like her son, I would leap out of our car in the middle of the road just to get away from my mother, over the most trivial of offenses. Like her son, I screamed obscenities at my mother shortly after moments of relative peace. And worse than this poor woman’s son, whose mindset toward his peers we can only guess, I will admit that I fantasized multiple times about taking ordnance to my classmates.
By the logic which leads Liza Long to say, “I am Adam Lanza’s mother,” I have to say: “I was Adam Lanza.”
I don’t say this to get attention. It’s in the past, and I honestly would prefer to pretend those years of my life never happened. I’ve struggled hard for psychological healing, and I sincerely believe I’ve made progress.
However, given recent events, I have a warning to offer - and an obligation to offer it.
I hope that by giving this explanation, including why I was the way I was, the world will work out that it is possible for kids like me – kids contemplating the most awful crimes - to get better. Kids like me and Liza Long’s son are not psychotic lost causes. We can be stopped. We can be saved.
What was wrong with me exactly is a complicated subject – I’ll leave that for the next installment of this story. For now, I just want to explain what goes through the head of a potentially dangerous teenager. If you are the parent of a child like me, or know someone who is, please listen:
We don’t take our rage out on you because we hate you, or because you’re bad parents, or even because we’re evil. We take it out on you because we know you’re a captive audience. Often, you’re the only audience we have. 
When I attacked my mother or got angry at her, it had very little to do with her and much more do with the feelings of rejection and helplessness and crazy that had been percolating in my head from the experience of isolation that comes with being different. And isolation makes us even more different than we started.
I’m not saying that angry, abusive, and dangerous teenagers just need to be hugged. There may well be cases where mental illness has set in and become so drastic that hugs alone would be comically insufficient. But what I am saying is that for me, at least, feeling loved and wanted by somebody was a precondition to health. If I had ever come to feel that my mother didn’t care about me, then everything would have looked hopeless. I would have given up on healing and started coming up with other, more drastic measures to make the world stop hurting me. Because of the way the media covers these events, it wouldn’t have taken a genius to figure out that for a social outcast of my stripe, there really was only one way to make the world stand up and take notice. My mother was the last line of defense that stopped it from getting that far.
Maybe a parent of a difficult child will read this and think, “I have made every possible effort to show my love and support – and my kid is still a little monster.”
The problem is that what is obvious to a normal adult is not always obvious to an abnormal child. Children like me will look for reasons to ignore love, especially if we feel the people who love us are also hurting us.
That seems to be what happened between Nancy and Adam Lanza. Nancy Lanza had spent time volunteering at Sandy Hook elementary. She also, understandably, had sought to have Adam involuntarily committed. Those two facts together seem to have led Adam to the conclusion – perfectly logically from the point of view of a kid like him and like me as I then was – that his mother cared more about the children of Sandy Hook than she did about him. In his reaction and rage, a shooter was born.
Parents, I cannot stress this enough: the healing process starts with you. Not the mental health community. Not the police. Not the government. Not the school. You. 
I know it’s hard. I know that we’re asking for the most love when we are least loveable. I can only promise that we – or some of us – will sooner or later understand and recognize the heroism of what you did.
If you throw your child away like a broken toy, or treat them like someone else’s problem, they will be lost altogether. Your child may be too far gone for you to fix alone, but that doesn’t mean you can do nothing. My mother did almost everything, and if you ask her now, she’ll admit she was deadly worried about me ending up on the news - as worried about me as Liza Long is about her son. 
She was right to be, because at one time in my life, I was Adam Lanza. I was Eric Harris and Dylan Klebold. I was Seung-hui Cho. I was James Holmes. I was Michael. But my mother held fast. She is the main reason why, unlike theirs, my experience can be described in the past tense.

[Article of Interest] I Was Adam Lanza

By David Frum

Recently, the Huffington Post published an article titled “I am Adam Lanza’s mother” by a woman named Liza Long. The article presents a picture of a 13-year-old boy who threatened his mother, sometimes going so far as to pull a knife on her, scream obscenities at her, and leap out of cars as they’re driving down the highway.

The rest of the world has reacted to the idea of such a child with horror and incomprehension. I sympathize with the horror. I can only wish that I shared the incomprehension. I understand, intimately, how Liza Long’s son feels. I was like him.

Like the author of that piece, Liza Long, my mother had no idea what to do about my sudden transformation (in my case, around 16) into a borderline homicidal maniac. Like her son, I used knives to try and make my threats of violence seem more real. Like her son, I would leap out of our car in the middle of the road just to get away from my mother, over the most trivial of offenses. Like her son, I screamed obscenities at my mother shortly after moments of relative peace. And worse than this poor woman’s son, whose mindset toward his peers we can only guess, I will admit that I fantasized multiple times about taking ordnance to my classmates.

By the logic which leads Liza Long to say, “I am Adam Lanza’s mother,” I have to say: “I was Adam Lanza.”

I don’t say this to get attention. It’s in the past, and I honestly would prefer to pretend those years of my life never happened. I’ve struggled hard for psychological healing, and I sincerely believe I’ve made progress.

However, given recent events, I have a warning to offer - and an obligation to offer it.

I hope that by giving this explanation, including why I was the way I was, the world will work out that it is possible for kids like me – kids contemplating the most awful crimes - to get better. Kids like me and Liza Long’s son are not psychotic lost causes. We can be stopped. We can be saved.

What was wrong with me exactly is a complicated subject – I’ll leave that for the next installment of this story. For now, I just want to explain what goes through the head of a potentially dangerous teenager. If you are the parent of a child like me, or know someone who is, please listen:

We don’t take our rage out on you because we hate you, or because you’re bad parents, or even because we’re evil. We take it out on you because we know you’re a captive audience. Often, you’re the only audience we have

When I attacked my mother or got angry at her, it had very little to do with her and much more do with the feelings of rejection and helplessness and crazy that had been percolating in my head from the experience of isolation that comes with being different. And isolation makes us even more different than we started.

I’m not saying that angry, abusive, and dangerous teenagers just need to be hugged. There may well be cases where mental illness has set in and become so drastic that hugs alone would be comically insufficient. But what I am saying is that for me, at least, feeling loved and wanted by somebody was a precondition to health. If I had ever come to feel that my mother didn’t care about me, then everything would have looked hopeless. I would have given up on healing and started coming up with other, more drastic measures to make the world stop hurting me. Because of the way the media covers these events, it wouldn’t have taken a genius to figure out that for a social outcast of my stripe, there really was only one way to make the world stand up and take notice. My mother was the last line of defense that stopped it from getting that far.

Maybe a parent of a difficult child will read this and think, “I have made every possible effort to show my love and support – and my kid is still a little monster.”

The problem is that what is obvious to a normal adult is not always obvious to an abnormal child. Children like me will look for reasons to ignore love, especially if we feel the people who love us are also hurting us.

That seems to be what happened between Nancy and Adam Lanza. Nancy Lanza had spent time volunteering at Sandy Hook elementary. She also, understandably, had sought to have Adam involuntarily committed. Those two facts together seem to have led Adam to the conclusion – perfectly logically from the point of view of a kid like him and like me as I then was – that his mother cared more about the children of Sandy Hook than she did about him. In his reaction and rage, a shooter was born.

Parents, I cannot stress this enough: the healing process starts with you. Not the mental health community. Not the police. Not the government. Not the school. You

I know it’s hard. I know that we’re asking for the most love when we are least loveable. I can only promise that we – or some of us – will sooner or later understand and recognize the heroism of what you did.

If you throw your child away like a broken toy, or treat them like someone else’s problem, they will be lost altogether. Your child may be too far gone for you to fix alone, but that doesn’t mean you can do nothing. My mother did almost everything, and if you ask her now, she’ll admit she was deadly worried about me ending up on the news - as worried about me as Liza Long is about her son. 

She was right to be, because at one time in my life, I was Adam Lanza. I was Eric Harris and Dylan Klebold. I was Seung-hui Cho. I was James Holmes. I was Michael. But my mother held fast. She is the main reason why, unlike theirs, my experience can be described in the past tense.

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